HB 712-FN - AS AMENDED BY THE SENATE
27Mar2025... 1138h
06/05/2025 1987s
06/05/2025 2506s
06/05/2025 2508s
2025 SESSION
25-0438
05/09
HOUSE BILL 712-FN
AN ACT limiting breast surgeries for minors, relative to residential care and health facility licensing, and relative to the collection and reporting of abortion statistics by health care providers and medical facilities.
SPONSORS: Rep. Mazur, Hills. 44; Rep. Kofalt, Hills. 32; Rep. Reinfurt, Hills. 29; Rep. Seidel, Hills. 29; Rep. DeVito, Rock. 8; Rep. Litchfield, Rock. 32; Rep. Notter, Hills. 12; Rep. Noble, Hills. 2; Rep. Colcombe, Hills. 30; Rep. Layon, Rock. 13; Sen. Murphy, Dist 16; Sen. Sullivan, Dist 18
COMMITTEE: Health, Human Services and Elderly Affairs
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AMENDED ANALYSIS
This bill:
I. Limits breast surgeries for minors to only those procedures needed to treat malignancy, injury, infection, or malformation and those needed to reconstruct the breasts after such procedures.
II. Requires the collection and reporting of certain abortion statistics by health care providers, medical facilities, and the department of health and human services. The reporting requirement replaces a provision in the fetal life protection act stating that nothing in the subdivision shall be construed as creating or recognizing a right to abortion.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
27Mar2025... 1138h
06/05/2025 1987s
06/05/2025 2506s
06/05/2025 2508s 25-0438
05/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Five
AN ACT limiting breast surgeries for minors, relative to residential care and health facility licensing, and relative to the collection and reporting of abortion statistics by health care providers and medical facilities.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Subdivision; Limitations on Breast Surgeries for Minors. Amend RSA 329 by inserting after section 50 the following new subdivision:
Limitations on Breast Surgeries for Minors
329:51 Limitations on Breast Surgery for Minors. This subdivision is intended to limit permissible breast surgeries on people under the age of 18 to only those procedures needed to treat malignancy, injury, infection, or malformation and those needed to reconstruct the breasts after such procedures.
329:52 Definitions. In this subdivision:
I. “Abnormal development” means:
(a) “Gynecomastia” which is the abnormal development of breast tissue in biological males;
(b) “Macromastia” which is excessive development of breast tissue in biological females and includes juvenile hypertrophy of the breast and gigantomastia; or
(c) “Symptomatic macromastia” is macromastia which causes pain, deformity and/or recurrent skin infection.
II. “Breast surgery” includes:
(a) “Mammaplasty” which means surgery to reshape or reside the breasts by removing or transplanting tissue or inserting implants;
(b) “Mastectomy” which means surgery to remove all breast tissue; and/or
(c) “Mastopexy” which means surgery to lift the breast.
III. "Malignant" means cancerous or otherwise dangerous to the physical health of the person including physiology compromised by infection, lack of blood flow, or physical injury.
VI. “Margin” means the healthy tissue removed around malignant tissue to ensure that all malignancy has been removed, and any additional tissue as recommended by relevant medical guidelines.
VI. “Transgender chest surgery” means surgery to remove the breasts of a biological female through mastectomy or to increase the size of breasts of a biological male through augmentation mammaplasty, only in such cases where there is no medical diagnosis recommending such surgery to remove the breasts or increase the size of breasts.
329:53 Prohibitions and Enforcement.
I. Pursuant to this subdivision and RSA 332-M, no physician shall perform transgender chest surgery on a person under 18 years of age.
II. No physician shall perform breast surgery on a person under 18 years of age unless one or more of the following conditions are met:
(a) The procedure is subsequent to a diagnosis of cancer which necessitates such a procedure as part of a treatment plan;
(b) The procedure is needed to remove malignant tissue and an appropriate margin, and lymph nodes as indicated;
(c) Reconstruction of breast tissue to restore the breasts after injury or infection which requires the removal of breast tissue to restore the physical health of the person;
(d) The procedure is needed to correct gynecomastia and symptomatic macromastia; or
(e) Treatment of congenital deformities of the breast and/or chest wall.
III. A violation of this subdivision is unprofessional conduct and is subject to discipline by the board of medicine under RSA 329, in conjunction with the office of professional licensure and certification under RSA 310. A violation of this subdivision shall not be grounds for additional civil or criminal liability.
2 Title Change. Amend the title of RSA 332-M to read as follows:
CHAPTER 332-M
PROHIBITING [GENITAL] GENDER [REASSIGNMENT] SURGERY ON MINORS
3 Definition of Gender Reassignment Surgery Added. Amend RSA 332-M:2 by inserting after paragraph III the following new paragraph:
III-a. "Gender surgery" includes genital gender reassignment surgery, transgender chest surgery as defined in RSA 329:52, VI, facial feminization or masculinization surgery, and/or removal of the reproductive organs for the purposes of gender identity including hysterectomy, oophorectomy, salpingo-oorphorectomy, and/or orchiectomy.
4 Prohibition of Gender Surgery on Minors. Amend RSA 332-M:3 to read as follows:
332-M:3 Prohibition of [Genital] Gender [Reassignment] Surgery on Minors.
I. A physician shall not perform [genital] gender [reassignment] surgery on minors in the state of New Hampshire.
II. Physicians are not prohibited from performing:
(a) Reconstructive surgeries on [the genitalia of] minors to correct malformation, malignancy, injury or physical disease;
(b) Removal of malignant, malformed, or otherwise damaged [genitalia] tissue;
(c) Genital surgeries on minors with disorders of sex development; or
(d) Male circumcision; or
(e) Breast surgery subject to the conditions of RSA 329:53, II.
5 Enforcement. Amend RSA 332-M:4, I to read as follows:
I. Any [referral for or] provision of [genital] gender [reassignment] surgery to an individual under 18 years of age is unprofessional conduct and is subject to discipline by the appropriate licensing entity or disciplinary review board with competent jurisdiction in this state.
6 Residential Care and Health Facility Licensing; Proceedings of Residential Care Facility Quality Assurance Program; Confidentiality. Amend RSA 151:5-c, I to read as follows:
I. To help assure quality care of residents in licensed residential care facilities, such facilities [may voluntarily] shall maintain a quality assurance program for its residents as set forth in this section.
7 Residential Care and Health Facility Licensing; Investigations and Consultations. Amend RSA 151:6, I to read as follows:
I. The department of health and human services may investigate, in response to a complaint alleging a violation of this chapter or when it has good reason to believe that the provisions of this chapter or rules adopted under this chapter have been violated by any facility licensed under this chapter or agency required to be licensed in accordance to RSA 151:2, I or any facility providing services beyond room and board to 2 or more individuals unrelated to the owner or manager. Such investigations shall be conducted in accordance with rules adopted by the commissioner of the department of health and human services under RSA 151:9. The commissioner of the department of health and human services shall, when necessary, seek the assistance of local and state law enforcement authorities in order to complete its investigation. Investigation results
shall be provided as a written report that identifies any noncompliance with this chapter and applicable rules adopted under this chapter. The results of investigations shall be posted on the department’s website in the manner determined by the commissioner of the department of health and human services. The results so posted shall indicate the facilities and services investigated and the results for each such facility or service. Investigation results shall not be subject to RSA 151:13.
8 Residential Care and Health Facility Licensing; Annual Inspection. Amend RSA 151:6-a, II(c) to read as follows:
(c) Facilities shall [not] be required to post notices to correct issued under subparagraph (a) of this paragraph.
9 New Subparagraph; Residential Care and Health Facility Licensing: Annual Inspection. Amend RSA 151:6-a, II by inserting after subparagraph (e) the following new subparagraph:
(f) The results of all inspections under this paragraph shall be posted to the department’s website in the manner determined by the commissioner of the department of health and human services. The results so posted shall indicate the facilities and services inspected and the results for each such facility or service. Inspection results shall not be subject to RSA 151:13.
10 Residential Care and Health Facility Licensing; Civil Fines. Amend RSA 151:16-b to read as follows:
151:16-b Civil Fines. All [administrative fines and other] civil monetary penalties collected by the department from facilities licensed under this chapter shall be kept by the state treasurer in a separate, non-lapsing, interest bearing account. Interest earned on moneys deposited in the account shall be deposited into the account. The moneys in the account shall be used by the department for the protection of the health and property of residents of facilities licensed under this chapter.
11 Residential Care and Health Facility Licensing; Patients' Bill of Rights. Amend RSA 151:21, XXIII(b)(1)(D) to read as follows:
(D) Visitors are noncompliant with written [hospital] facility policy.
12 Residential Care and Health Facility Licensing: Patients' Bill of Rights. Amend RSA 151:21, XXIII(f)(3)to read as follows:
(3) [Hospital] Facility visitation policy detailing the rights and responsibilities specified in this paragraph, and the limitations placed upon those rights by written [hospital] facility policy on its website.
13 Residential Care and Health Facility Licensing; Dementia Training for Direct Care Staff in Residential Facilities; Continuing Education. Amend RSA 151:50 to read as follows:
151:50 Continuing Education. The commissioner shall adopt rules to require at least 6 hours of initial [continuing] education for covered administrative staff members and covered direct service staff members and shall require at least 4 hours of [ongoing training] continuing education each calendar year. Such continuing education shall include new information on best practices in the treatment and care of persons with dementia.
14 Collection and Reporting of Abortion Statistics. ? RSA 329:49 is repealed and reenacted to read as follows:
329:49 Collection and Reporting of Abortion Statistics.
I.? Any health care provider who performs an abortion as defined in RSA 132:32, I, shall report the following information in writing to the medical facility in which the abortion is performed:
(a) ?Date when the abortion was performed;
(b) County where the abortion was performed;
(c) ? Age group of the pregnant patient when the abortion was performed;
(d) ?Residence of patient as “in-state” or “out-of-state” when the abortion was performed;
(e) ?Method used to perform the abortion; and
(f) ? Estimated gestational age when the abortion was performed.
II. The aggregated report containing the information and data required by this section shall be transmitted by the medical facility to the department of health and human services. These reports shall not identify the patient or health care provider by name or include other personally identifiable information.
III. The commissioner of the department of health and human services shall prepare from these data such aggregated statistical trends and tables with respect to maternal health, abortion methods, and estimated gestational age, and shall make an annual aggregated report thereof to the general court.
IV. The commissioner of health and human services shall adopt rules, pursuant to RSA 541-A, relative to:
(a) The form in which data shall be filed under paragraph I.
(b) The cadence of reporting from medical facilities.
(c) Confidentiality of data collected and disclosed under this section subject to the provisions of this section.
(d) Procedures and written requirements for obtaining, using, and protecting data provided by the department of health and human services under this section.
V. Any medical facility that willfully fails to comply with the provisions of this section shall be subject to an administrative fine of $100 for each business day of noncompliance.?
15 Effective Date.
I. Sections 10, 11, 12, and 13 of this act shall take effect July 1, 2025.
II. Sections 1, 6, 7, 8, and 9 of this act shall take effect 60 days after its passage.
III. Section 14 of this act shall take effect January 1, 2207.
IV. The remainder of this act shall take effect January 1, 2026.
25-0438
4/1/25
HB 712-FN- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2025-1138h)
AN ACT limiting breast surgeries for minors.
FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
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Estimated State Impact | ||||||
| FY 2025 | FY 2026 | FY 2027 | FY 2028 | ||
Revenue | $0 | $0 | $0 | $0 | ||
Revenue Fund(s) | None | |||||
Expenditures* | $0 | Indeterminable Increase more than $10,000 to $100,000 or less per fiscal year | ||||
Funding Source(s) | General Fund | |||||
Appropriations* | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
*Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill | ||||||
METHODOLOGY:
This bill places limitations on permissible breast surgeries on people under the age of 18 to only those procedures needed to treat malignancy, injury, infection, or malformation and those needed to reconstruct the breasts after such procedures.
The Department of Health and Human Services (DHHS) states this bill could lead to an uncertain increase in General Fund expenditures, given that gender surgery for individuals under 19 is an extremely rare occurrence. Furthermore, DHHS suggests that the bill might result in minimal, if any, savings to Medicaid expenditures, as prohibiting breast surgery for minors could lead to the substitution of other services, potentially offsetting or exceeding any anticipated savings. The indeterminable increase in expenditures is anticipated to be more than $10,000 to $100,000 or less.
The Department of Justice (DOJ) states that the bill incorporates prohibitions in RSA 332-M which includes a provision to authorize the Attorney General to bring legal action to enforce the law, as well as other private rights actions. However, the fiscal impact is likely to be under $10,000 although it is indeterminable as the amount of cases is unknown. Additionally, the DOJ could potentially be involved in any complaints of unprofessional conduct to the Office of Professional Licensure and Certification for legal guidance.
The Judicial Branch indicates that this bill would result in an increase of litigation under $10,000.
This could possibly result in an increase in civil cases in the Superior Court, however, there is no way to predict how many such actions would occur so any such increase is indeterminable. The Judicial Branch has provided average cost information for civil cases in the Superior Court:
NH Judicial Branch Average Civil Case Estimates
Judicial Branch Average Cost | FY 2025 | FY 2026 |
Superior Court Complex Civil Case | $1,430 | $1,473 |
Superior Court Routine Civil Case | $535 | $552 |
Common Civil Case Fees
Superior Court Fees | As of 2/12/2020 |
Original Entry Fee | $280 |
Third-Party Claim | $280 |
Motion to Reopen | $160 |
It is assumed that any fiscal impact would occur after FY 2025.
AGENCIES CONTACTED:
Department of Health and Human Services, Department of Justice, and Judicial Branch
| Date | Amendment |
|---|---|
| March 11, 2025 | 2025-0933h |
| March 19, 2025 | 2025-1138h |
| May 7, 2025 | 2025-1987s |
| June 4, 2025 | 2025-2506s |
| June 4, 2025 | 2025-2508s |
| June 4, 2025 | 2025-2512s |
| Date | Body | Type |
|---|---|---|
| March 3, 2025 | House | Hearing |
| March 19, 2025 | House | Exec Session |
| March 19, 2025 | House | Floor Vote |
| April 23, 2025 | Senate | Hearing |
| April 23, 2025 | Senate | Hearing |
| April 23, 2025 | Senate | Hearing |
| May 15, 2025 | Senate | Floor Vote |
| May 15, 2025 | Senate | Floor Vote |
| May 15, 2025 | Senate | Floor Vote |
| May 15, 2025 | Senate | Floor Vote |
| June 5, 2025 | Senate | Floor Vote |
June 18, 2025: Conferee Change; Senator Abbas Replaces Senator Prentiss; SJ 17
June 17, 2025: Conference Committee Meeting: 06/17/2025 04:00 pm LOB 305
June 16, 2025: Conference Committee Meeting: 06/16/2025 03:00 pm LOB 202-204
June 12, 2025: Conferee Change; Senator Birdsell Replaces Senator Avard; SJ 16
June 11, 2025: President Appoints: Senators Rochefort, Avard, Prentiss; (In Recess 06/05/2025); SJ 16
June 11, 2025: Sen. Rochefort Accedes to House Request for Committee of Conference, MA, VV; (In recess 06/05/2025); SJ 16
June 10, 2025: Speaker Appoints: Reps. W. MacDonald, Kesselring, Kofalt, Drew 06/05/2025 HJ 16
June 10, 2025: House Non-Concurs with Senate Amendment 2025-1987s 2025-2506s and 2025-2508s and Requests CofC (Rep. Kofalt): MA VV 06/05/2025 HJ 16
June 5, 2025: Ought to Pass with Amendments #2025-1987s, and #2025-2506s #2025-2508s, RC 16Y-7N, MA; OT3rdg; 06/05/2025; SJ 15
June 5, 2025: Sen. Avard Floor Amendment # 2025-2508s, AA, VV; 06/05/2025; SJ 15
June 5, 2025: Sen. Birdsell Floor Amendment # 2025-2506s, AA, VV; 06/05/2025; SJ 15
June 5, 2025: Committee Amendment # 2025-1987s, AA, VV; 06/05/2025; SJ 15
May 19, 2025: Committee Report: Ought to Pass with Amendment # 2025-1987s, 06/05/2025, Vote 3-2;
May 15, 2025: Committee Report: Ought to Pass with Amendment # 2025-1987s, 05/15/2025, Vote 3-2; SC 22
May 15, 2025: Special Order to 06/05/2025, Without Objection, MA; 05/15/2025 SJ 13
May 15, 2025: Committee Report: Ought to Pass with Amendment # 2025-1987s, 05/15/2025, Vote 3-2; SC 21
May 7, 2025: Committee Report: Ought to Pass with Amendment # 2025-1987s, 05/15/2025, Vote 3-2; SC 21
April 16, 2025: ==TIME CHANGE== Hearing: 04/23/2025, Room 101, LOB, 09:30 am; SC 18
April 16, 2025: ==ROOM CHANGE== Hearing: 04/23/2025, Room 103, SH, 09:30 am; SC 18
April 14, 2025: Hearing: 04/23/2025, Room 101, LOB, 10:15 am; SC 18
March 28, 2025: Introduced 03/27/2025 and Referred to Health and Human Services; SJ 10
March 27, 2025: Ought to Pass with Amendment 2025-1138h: MA RC 200-165 03/27/2025 HJ 11 P. 58
March 27, 2025: Amendment # 2025-1138h: AA VV 03/27/2025 HJ 11 P. 58
March 19, 2025: Minority Committee Report: Inexpedient to Legislate
March 19, 2025: Majority Committee Report: Ought to Pass with Amendment # 2025-1138h 03/19/2025 (Vote 10-8; RC) HC 17 P. 59
March 13, 2025: Executive Session: 03/19/2025 09:30 am LOB 201
Feb. 25, 2025: Public Hearing: 03/03/2025 01:00 pm LOB 306-308
Jan. 22, 2025: Introduced (in recess of) 01/09/2025 and referred to Health, Human Services and Elderly Affairs HJ 3 P. 24